Free-style free flap

Advancements in microsurgical techniques as applied to perforator flaps have made harvesting flaps in a free-style manner a practical reality. A hand-held Doppler identifies sizable perforators on which flaps can be based. In free-style free flap harvesting, any region of the body can be chosen as a donor site as long as there is an audible pulsatile Doppler signal. The value of the free-style free flap concept ties in its ability to overcome anatomical variations. The clinical application of raising flaps in a free-style manner has been demonstrated in the thigh where flaps have been raised safety and reliably in spite of the many anatomical uncertainties in this area. Flaps can, thus, be designed and raised in any region of the body to suite the unique requirements of individual cases. However, limitations to the clinical application of the free-style free flap should be noted; the course of the perforator may be unpredictable. Small and long perforators may be difficult to harvest and inset. Furthermore, the skin territory and intra-operative flap thinning should more conservative compared with conventional flaps. These shortcomings can however be overcome by clinical experience and improvement in surgical techniques. (C) 2008 Published by Elsevier Ltd.